[SEPARATE LEGAL AND MEDICAL AND SOCIAL ASPECTS OF POSTTHEAL TRANSPLANTATION IN UKRAINE].

Organ donation is one of the topical issues in the field of medicine around the world. Although the practice of transplantation exists in most countries of the world, there are still many unresolved issues. One of them is the issues related to postmortem organ transplantation in Ukraine. Despite the significant increase in the scale of transplantation of human organs, tissues and cells, today there is a need to improve the mechanism of organ transplantation from deceased persons, both at the legal level and in the provision of medical services. The purpose of the study is to consider problematic issues related to posthumous transplantation, in particular its legal support, ethical aspects, medical opportunities for improving the procedure for providing organs to the recipient, as well as looking for prospects for their resolution. To achieve this goal, an analysis of the existing regulatory framework in the field of transplantation was carried out, the experience of Ukraine and foreign countries on the issue under study was analyzed, the following methods were used: comparative legal, statistical, induction, analysis, synthesis. Based on the study, the authors conclude that the regulation of transplantation in Ukraine should be not only at a high legal level, but also implemented in practice into the Unified State Information System for Organ and Tissue Transplantation, which will allow timely and efficient provision of organs to the recipient.

Statin adherence and LDL cholesterol levels. Should we assess adherence prior to statin upgrade?

BACKGROUND: Adherence to statin therapy has been shown to be suboptimal. In statin-treated patients with residual elevated low density lipoprotein cholesterol (LDL-C) levels the physician must decide whether to switch to a more potent statin or try and achieve better adherence. We examined the association between adherence and LDL-C within low, moderate and high intensity statin groups in a "real world" setting. METHODS: We assessed annual adherence by the mean MPR (Medication Possession Ratio = number of purchased/prescribed daily doses) in unselected patient group. Statins were stratified (ACC/AHA Guideline) into low, moderate and high intensity groups. The impact of adherence on LDL levels was assessed by LOESS (locally weighted scatter plot smoothing). RESULTS: Out of 1183 patients 173 (14.6%) were treated with low, 923 (78.0%) with moderate and 87 (7.4%) with high intensity statins. Statin intensity was inversely associated with adherence (MPR 77±21, 73±22 and 69±21% for low, moderate and high intensity respectively, p=0.018). Non-adjusted LDL levels decreased with higher adherence: a 10% adherence increase resulted in LDL decrease of 3.5, 5.8 and 7.1mg/dL in low, moderate and high intensity groups. Analysis of the adherence effect on LDL levels adjusted for age, DM and ischemic heart disease showed that MPR above 80% was associated with an additional decrease in LDL levels only in the high intensity group. CONCLUSIONS: Increased adherence to statins beyond an MPR of 80% improves LDL levels only among patients given high intensity therapy. Switching from lower to higher intensity therapy may be more effective than further efforts to increase adherence.

[Etiology of purulent infections in the Tiumen' region based on hospital data]. / Etiologiia gnoinykh infektsii v Tiumenskoi oblasti po dannym bol'nichnogo statsionara.

A study of laboratory findings for 474 examined patients, who were discharged from the Surgical Department of the Tyumen Regional Clinical Hospital, showed that S. aureus caused the infectious processes in 31.7% of the examinees. Oxacyllinresistant strain S aureus made up 9.7%.e examinees, and 22.6% of pathologies were caused in them by E. coli. E. coli was frequently found to be combined with polyresistant strains E. faecalis, E. faecium, K. pneumoniae and P. aeruginosa, which could be explained by the circulation of hospital strains within a hospital and by the selection of microorganisms with a high resistance level to antibacterial drugs.

[High-intensity laser irradiation in the treatment of patients with non-healing stomach ulcers]. / Vysokointensivnoe lazernoe izluchenie v lechenii bol'nykh s dlitel'no ne zazhivaiushchimi iazvami zheludka.

A new modality--strong impulse laser radiation--has been tried in the treatment of 99 patients suffering from atonic gastric ulcer. It was found to promote cicatrization in 87% of cases. The effect may be due to correction of immunity and local microcirculation, affection of causative agents. Strong impulse laser radiation appears to be superior to ++trans-endoscopic treatments in safety and availability.

[The role of the hypophyseal-gonadal system in forming long-term nonhealing duodenal ulcers]. / Rol' gipofizarno-gonadnoi sistemy v formirovanii dlitel'no nezazhivaiushchikh iazv dvenadtsatiperstnoi kishki.

The authors provide the data on the hormonal spectrum (STH, gastrin, sex hormones) in patients with long unhealing duodenal ulcers. It is shown that changes in the concentrations and ratios of the concentrations of hypophyseal-gonadal hormones may serve as a defensive adaptation reaction of the body and may be due to activation of the adaptation systems that mediate the neurohumoral mechanisms of regulation. Such changes are more remarkable in patients with common peptic ulcer. Apparently, in patients with long unhealing ulcers, these mechanisms tend toward depletion, as a result of which the other mechanisms start prevailing (microcirculatory disorders, immunologic abnormalities, pathological microflora).

[Age-related features of the state of plasma lipoproteins in rats with hereditary retinal degeneration]. / Vozrastnye osobennosti sostava plazmennykh lipoproteidov u krys s nasledstvennoi degeneratsiei setchatki.

The content of lipids and lipoproteins was determined in the blood plasma of Campbell rats with inherited retina degeneration and Wistar rats used as control. It was shown that in the 30-day old Campbell rats the content of cholesterol in high density lipoproteins sufficiently exceeded that of control. When the distribution of lipoproteins particles in the density gradient was studied after ultracentrifugation, some "anomalous" particles were revealed in the 30-45 day old rats with inherited retina degeneration, which with respect to the flotation rate occupy intermediate position between the low and high density lipoproteins. The obtained data show that the development of inherited retina degeneration in rats involves a disturbance, of the lipoprotein spectrum of blood plasma.

The influence of the lipid bilayer phase state on the p-aminohippurate (PAH) transport and the activity of the alkaline phosphatase in brush-border membrane vesicles from normal and mutant rats.

The kinetic parameters of p-aminohippurate transport and activity of the alkaline phosphatase were studied using brush-border membrane vesicles isolated from the kidney cortex of normal and mutant (strain of Campbell) rats. p-Aminohippurate (PAH) transport of both normal and mutant animals was carried out by the mechanism of facilitated diffusion. The apparent Michaelis constant at 36 degrees C was equal to 7 mM, the maximal rate of PAH transport was 15 nmol/min per mg protein and the constant of inhibition by probenecid was 0.5 mM for normal rats and, respectively, 29 mM, 62 nmol/min per mg protein and 1.4 mM for mutant rats. The Arrhenius plot for the PAH transport and activity of the alkaline phosphatase showed the breakpoints at 28-30 degrees C for normal rats and at 36-38 degrees C for the Campbell strain rats. The thermotropic phase transitions detected by the EPR method with 5-doxylstearate as a probe were recorded at 21-30 degrees C and 30-35 degrees C for normal and mutant rats, respectively. Therefore, characteristic features of the PAH carrier and alkaline phosphatase activity in normal and Campbell strain rats are determined by the difference in the phase state of their membrane lipid bilayers. We suppose that mutation in the Campbell strain gives rise to a membrane pleiotropic effect which enables us to understand the mechanism of genetic control of the lipid structure and membrane fluidity.

[Changes in the properties of photostimulated cyclic nucleotide phosphodiesterase from the retina of rats with hereditary retinal degeneration]. / Izmenenie svoistv fotostimuliruemoi fosfodiésterazy tsiklicheskikh nukleotidov setchatki krys s nasledstvennoi degeneratsiei étoi tkani.

A degree of extractability and activation of cGMP-phosphodiesterase (PDE) (EC. 3.1.4.17) from the rod outer segment membranes was studied in Campbell rats with inherited retinal degeneration and control Wistar rats as compared to the control, the PDE extractability in the diseased rats was found to be considerably lower, which manifested as early as the 15th day of the postnatal life. Changes in the GTP-stimulated and basal PDE activity were observed in Campbell rats. Beginning from the 25th day of the postnatal life the GTP-stimulated PDE of degenerative retina decreased and by the 60th day it reached the basal activity level in these animals. In the diseased rats the first 57 days of postnatal life the basal activity of PDE was sufficiently higher, followed by a sharp decrease reaching the basal activity level of the control rats. The obtained data on the changed PDE activity are likely to be a result of the disturbance in the protein-lipid interaction and a change in the external layer of the photoreceptor membranes in rats with inherited retinal degeneration.

[The system of active transport of organic acids in the proximal tubules of rats with hereditary retinal degeneration (Campbell strain)]. / Sostoianie sistemy aktivnogo transporta organicheskikh kislot v proksimal'nykh kanal'tsakh krys s nasledstvennoi degeneratsiei setchatki (liniia Kempbell).

Active transport of organic acids (ATOA) in proximal renal tubules of Campbell, Wistar and random-bred rats was studied by contact microfluorometry with anion fluorescein as a marker. Beginning with the 60th day of life this transport in Campbell rats was characterized by a lower equilibrium uptake of fluorescein by the tubules, by altered sensitivity to AMP and adenosine, and by no response to unilateral nephrectomy. It is assumed that ATOA in Campbell rats plays a certain role in the pathogenesis of retinitis pigmentosa.

[Changes in the blood uric acid levels in patients with retinitis pigmentosa and in rats with hereditary retinal degeneration]. / Izmeneniia soderzhaniia mochevoi kisloty v krovi u liudei, bol'nykh pigmentnym retinitom, i u krys s nasledstvennoi degeneratsiei setchatki.

The content of uric acid was measured in the blood of patients suffering from retinitis pigmentosa, as well as in the blood, retina, brain, liver and urine of rats with inherited retinal degeneration in the course of postnatal development. It was found that in the patients with retinitis pigmentosa, the concentration of uric acid in the blood serum was 50% higher as compared to normals. On the 8th day of life the content of uric acid in the blood of the sick rats was equal to 150% as compared to the normal animals. This difference persisted during the subsequent postnatal life. In the rats with inherited retinal degeneration, the content of this purine in the retina, brain and liver was approximately the same as that seen in the normal animals in all the studied periods of life. Meanwhile statistically significant changes in the uric acid content in the sick animals' urine appeared at an age of 1.5-2 months. It is believed that the identical line of changes in the uric acid content in the blood of the sick persons and rats points to similarity of the experimental disease of the animals to the disease in humans.

[Early changes in retinal 5'-nucleotidase activity in hereditary retinal degeneration]. / Rannie izmeneniia aktivnosti 5'-nukleotidazy setchatki pri ee nasledstvennoi degeneratsii.

Activity of soluble cGMP phosphodiesterase (PDE) and of two membrane enzymes, 5'-nucleotidase and Na,K-ATPase, was studied in the developing retina of rats with inherited retinal degeneration. It was found that by day 10 of life, the content of 5'-nucleotidase in the afflicted rats was significantly reduced as compared with controls. This difference was unchanged throughout the subsequent animals' life. Na,K-ATPase activity in the afflicted and normal animals was the same. Within the first 45 days of life, PDE calculated with respect to the rhodopsin content was not different as regards both the afflicted and normal rats. When calculated with respect to protein, the changes in PDE corresponded with the reported data. The data obtained allowed a suggestion to be made that changes in 5'-nucleotidase in inherited retinal degeneration are disease-specific. They are accounted for by changes in the enzymes of nonphotoreceptor retinal membranes. The changes in PDE may be regarded as secondary, correlating with variation in the number of the photoreceptor membranes.

[Changes in the activity of cyclic nucleotide phosphodiesterase and content of rhodopsin in retina during long illumination]. / Izmenenie aktivnosti fosfodiésterazy tsiklicheskikh nukleotidov i soderzhaniia zritel'nogopigmenta v setchatke pri dlitel'nom osveshchenii.

The phosphodiesterase activity in rat retina is found to decrease after a relatively short (1 h) and long (24 and 48 h) light exposition at 1200-1700 lx. illumination. The degree of decrease in the enzymic activity correlates with the exposure time. The rhodopsin capacity for regeneration is a criterion of the activity changes in the retina under the light effect. An hour illumination after the dark adaptation restores practically the initial level of the rhodopsin content and phosphodiesterase activity. A one- and two-day stay in the light causes a partial disturbance in the regeneration of rhodopsin and essential disturbances of the phosphodiesterase activity recovery in the retina.

[Biochemical disorders in hereditary retinal degeneration: changes in cyclic nucleotide phosphodiesterase activity and rhodopsin concentration in the retinas of Campbell rats]. / Biokhimicheskie narusheniia pri nasledstvennoi degeneratsii setchatki: izmeneniia aktivnosti fosfodiésterazy tsiklicheskikh nukleotidov i soderzhaniia rodopsina v setchatke krys linii Kémpbell.

A correlation was noted between alterations in activity of cGMP phosphodiesterase /PDE/ and in content of rhodopsin /R/ from rats of the Campbell strain with hereditary retina degeneration as well as from control animals of the Wistar strain. Dynamics of alterations in the PDE/R ratio was similar to both in impaired and healthy animals within the first 35 days of life. These data suggest that the decrease of the PDE activity in retina of the Campbell rats occurred due to destruction and removing of outer layer of photoreceptor cell segments, i.e. it was of the secondary nature rather than of primary pathogenetic importance. After 1.5 month of the life retina aqueous extract activated PDE of cyclic nucleotides in impaired rats, but did not cause inhibition as it was observed in healthy animals. The phenomenon appears to be due to various localization of PDE inhibitors and activators in retina as well as to destruction of the layer of rod outer segments in retina of impaired rats.

[Proteins of the retina and its pigmented epithelium in hereditary retinal degeneration]. / Belki setchatki i ee pigmentnogo épiteliia pri nasledstvennoi degeneratsii setchatki.

Water-soluble and membranous proteins of the retina and pigment epithelium were studied by electrophoresis in polyacrylamide gel in Campbell albino rats with inherited retinal dystrophy and in Wistar rats that served as control. It was shown that early changes in abnormal animals were characteristic of retinal proteins. The proteins affected in the first turn proved to be other than cyclic nucleotide phosphodiesterase or opsin. The changes in pigment epithelium were recorded to take place much later.

[Rhodopsin regeneration: role of interaction between the photoreceptors and pigment epithelium cells]. / Regeneratsiia rodopsina: znachenie vzaimodeistviia fotoretseptorov i kletok pigmentnogo épiteliia.

Regeneration of rhodopsin has been studied in the eyecup, isolated retina and retinal homogenate of frog Rana temporaia as well as in the eyecup and isolated retina of fish-flounder Limanda aspera (Pallas). Rhodopsin has been found to regenerate only in the eyecup of frog, while isorhodopsin appeared to be the final product in the frog retinal homogenate. Decrease in rhodopsin regeneration level has been resulted from addition of inhibitors--theophyllin (2.10-2 M), papaverine (10-4--10-3 M) and strophantin (2.10-4 M) To the eyecup preparations (60, 20, 23%, consequently). A conclusion is made that structural connection between pigment epithelium cells and photoreceptors is necessary to provide regeneration of native rhodopsin.

[Protein inhibitor of cyclic nucleotide phosphodiesterase in the retina in hereditary degeneration]. / Belkovyi ingibitor fosfodiésterazy tsiklicheskikh nukleotidov v setchatki pri ee nasledstvennoi degeneratsii.

Thermostable protein fraction from retina of rats with hereditary retinal dystrophy (Hunter and Campbell strains) did not inhibit cyclic nucleotide phosphodiesterase. At the same time an inhibitory component, found in retina of Wistar rat, rabbit, frog and lamprey, was similar to the component from bovine retina. Quantity of the inhibitory component in normal rat retina decreased considerably within postnatal period (12 days--3 months). Thermostable proteins, isolated from Campbell rat retina, differed from that of Hunters' one by electrophoretic properties while both preparations were dissimilar to the protein of normal rat. Protein bands, containing inhibitory component from dystrophic rat retina, appear to be less distinct as compared to those of normal rat. These proteins, eluated from the bands of Campbell rats, activated phosphodiesterase but the preparations from Hunter rats did not influence on it.

[Resynthesis of rhodopsin in rats with hereditary retinal dystrophy]. / Resintez rodopsina u krys s nasledstvennoi distrofiei setchatki.

Resynthesis of rhodopsin both in the retina and the eye cup was studied in albino rats (Campbell line) and in rats with pigmented eyes (Hunter line) with hereditary retinal dystrophy. Wistar rats and those of MSU line were used as controls, respectively. The rate of resynthesis of rhodopsin after its bleaching in the retina of dystrophic animals appeared to be much less than that in the normal ones, and decreased during the disease. When clear morphological changes were seen, only 50% of the previously bleached pigment was capable of regeneration during 2 hours of dark adaptation, the time being quite adequate for complete regeneration of rhodopsin in normal animals. It was found that in Campbell and Hunter rats breakdown and resynthesis of rhodopsin takes place not only in the retina but also in the layer of outer segment debris of photoreceptors located between the pigment epithelium cells and the retina.